BJOG : an international journal of obstetrics and gynaecology · 2005
Intra-operative introital ultrasound in Burch colposuspension reduces post-operative complications.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Viereck Volker, Bader Werner, Krauss Thomas, Oppermann Miriam, Gauruder-Burmester Annett, Hilgers Reinhard, Hackenberg Reinhard, Hatzmann Wolfgang, Emons Günter
Аннотация
OBJECTIVE: To determine the effect of intra-operative monitoring of bladder neck elevation on cure rate and post-operative complications in patients undergoing colposuspension.
DESIGN: Prospective, observational study.
SETTING: Urogynaecology units, university hospitals.
POPULATION: Ninety women operated on for genuine stress urinary incontinence.
METHODS: The topography of the bladder neck and proximal urethra was assessed with pre-, intra- and post-operative introital ultrasound. These measurements were repeated during follow up for up to 48 months after surgery. Burch colposuspension of the bladder neck was performed under intra-operative introital ultrasound control, with reference to the patients' individual pre-operative ultrasound, to achieve a vertical height correction of 1-10 mm.
MAIN OUTCOME MEASURES: Mid-term surgical outcome and post-operative complications.
RESULTS: Ninety patients underwent colposuspension and 50 (56%) completed 48 months of follow up; 85 women (94%) were objectively continent at 12-month follow up and 42 of 50 (82%) at 48-month follow up. Surgical elevation of the bladder neck resulted in a median intra-operative elevation of 9 mm (7 mm at 48 months). All post-operative measurements demonstrated a significant decrease in linear dorsocaudal movement of the bladder neck during straining (P < 0.001). Funnelling and hypermobility were still decreased 48 months after incontinence surgery (P < 0.001). Voiding difficulty and urgency were uncommon and associated with evidence of funnelling and hypermobility.
CONCLUSION: Intra-operative introital ultrasound standardises Burch colposuspension and thus might help to avoid overelevation and associated post-operative complications such as voiding difficulties and de novo urge incontinence without compromising the success of the operation.
DESIGN: Prospective, observational study.
SETTING: Urogynaecology units, university hospitals.
POPULATION: Ninety women operated on for genuine stress urinary incontinence.
METHODS: The topography of the bladder neck and proximal urethra was assessed with pre-, intra- and post-operative introital ultrasound. These measurements were repeated during follow up for up to 48 months after surgery. Burch colposuspension of the bladder neck was performed under intra-operative introital ultrasound control, with reference to the patients' individual pre-operative ultrasound, to achieve a vertical height correction of 1-10 mm.
MAIN OUTCOME MEASURES: Mid-term surgical outcome and post-operative complications.
RESULTS: Ninety patients underwent colposuspension and 50 (56%) completed 48 months of follow up; 85 women (94%) were objectively continent at 12-month follow up and 42 of 50 (82%) at 48-month follow up. Surgical elevation of the bladder neck resulted in a median intra-operative elevation of 9 mm (7 mm at 48 months). All post-operative measurements demonstrated a significant decrease in linear dorsocaudal movement of the bladder neck during straining (P < 0.001). Funnelling and hypermobility were still decreased 48 months after incontinence surgery (P < 0.001). Voiding difficulty and urgency were uncommon and associated with evidence of funnelling and hypermobility.
CONCLUSION: Intra-operative introital ultrasound standardises Burch colposuspension and thus might help to avoid overelevation and associated post-operative complications such as voiding difficulties and de novo urge incontinence without compromising the success of the operation.